If the death of parents and grandparents represents the death of our connections to the past, and the death of our spouse/partner represents that to the present and our seeable future, then the death of a child represents the death of a connection to the future. Virtually everyone who has incurred this loss agrees that there is no other loss as painful as that of a child. (While perinatal losses share the same characteristics as the loss of any other aged child, they have additional characteristics that I will address later.)
In his novel Dombey and Son, Charles Dickens described the anguish of losing a child when he wrote the following exclamation of a grieving father: “And can it be that in a world so full and busy, the loss of one weak creature makes a void in any heart, so wide and deep that nothing but the width and depth of vast eternity can fill it up!”

In her book Treatment of Complicated Mourning, Teresa Rando speaks of specific dilemmas that bereaved parents experience as the result of the death of their child.

A basic tenet of the assumptive world that most of us have is that the new replaces the old. All around us, the notion prevails that the young are stronger, quicker, prettier, mentally sharper, more vibrant, better, etc. The cycle of life (birth, growth, aging, and death) continues endlessly for all things we see in nature from stars, to mountains, to plants, to animals, to humans. We even see the cycle in such diverse areas as organizations, technology, and science. It is obviously a law of nature. However, there are times when the cycle fails. Some young do die before the old and we are left with the sense that the laws of nature have been violated. In no case do we feel this more deeply than when a child dies. The most consistent statement bereaved parents make to me is that they never imagined that they would have to bury their child – he/she was not supposed to die before they did. The guilt they feel for still being alive is a very onerous burden to bear.

For most parents, each child they have is an embodiment of their hopes, dreams, fantasies, expectations, and wishes for the future. An important element of this future is the comfort of knowing there will be someone to carry on the family’s name and to remember them when it is their time to go. The child’s remembrances, as well as the continuance of the parents’ thoughts values, beliefs, traditions, and attitudes, give the parents a degree of immortality and a way to make an ongoing contribution to the world. However, when a child dies, that projection into the future is gone. The parents suffer a devastating blow to this sense of immortality and the potential for their continuing influence in the world. Another hope and expectation of parents is that their children will be available to take care of them when they are no longer able to care for themselves. Even though parents do not readily admit it, the death of a child and the subsequent loss of future physical, financial, emotional, or social support can weigh heavily on them.

A third group of dilemmas that parents can face when they lose a child revolves around roles and responsibilities. Frequently parents come to me feeling they have failed in their role as protectors and providers of the child – otherwise, their child would still be alive – even if they know there was nothing they could have done to prevent the death. This sense of failure can leave them feeling confused, violated, powerless, and guilt-ridden. Their diminished sense of who they are can result in disillusionment, emptiness, and insecurity.

When we have children, we make sacrifices and investments in them. These are the result of not only the hopes, dreams, etc. given above, but also the needs, feelings, thoughts, behaviors, and love we project onto the child. The child/parent relationship is the most intense relationship in life. The child is not only a physical extension of the parents, but an emotional and psychological one as well. There is an irreplaceable two-way flow of love. When the child dies the investment we have made is gone and with it the flow of the love that previously existed. Bereaved parents describe the impact being as if a part of their inner core was ripped out. In her book, Rando quotes a widow who stated: “When you lose your spouse, it is like losing a limb; when you lose your child, it is like losing a lung.” The parents still love the child, in absence, but the parents are not able to receive the special, reciprocal love in return. The one who uniquely needs, depends upon, admires, appreciates, and loves them is physically gone.

In summary, when a child dies, parents can feel as if the laws of nature have been overruled, their future is forever changed and uncertain, they have failed in the role as parents, and they have lost the most important source and recipient of their love that they will ever know.